My 64-year-old wife has never had a mammogram and is reluctant to get one now. Do you have any suggestions on what might help persuade her to obtain a mammogram?
Studies have shown that the most common reasons women give for not having a mammogram is they never thought about it, do not believe they have any need for one, and their doctors fail to suggest it. Since you mention your wife's reluctance to have a mammogram, she has at least thought about it! But she seems unaware of the benefits. She also may harbor unrealistic fears about having a mammogram.
Successful treatment of breast cancer depends heavily on removing the cancer before it spreads. Five-year survival is about 93% for localized breast cancer, 72% when the cancer has spread to local lymph nodes and only 17% with distant spread.
Breast cancers are usually present for many years before they produce any symptoms or can be felt on examination by a woman or her doctor, and studies have shown that cancers can be detected by mammography an average of at least three years before they can be detected by physical examination.
Based on the strong scientific evidence for the benefits of mammography in women over age 50, the American Cancer Society recommends a screening mammography and clinical breast examination annually for all such women.
Many older women do not realize that the rate of breast cancer increases with increasing age. For example, the incidence of breast cancer is about six times higher in women over the age of 65 than in younger women.
Some women worry about the dangers of radiation or the pain associated with mammography. It is true that early X-ray equipment used for mammography delivered a significant amount of radiation. The new machines require a relatively small amount of radiation -- equal to the amount received from traveling outdoors in a car for 10 minutes.
It is also true that high quality mammograms require breast compression, causing brief, mild discomfort, which in most cases proves to be less daunting than expected.
If cost is a consideration, you should know that mammograms are covered by nearly all insurance plans, including Medicare and Medicaid. Those who lack insurance should contact their local chapter of the American Cancer Society for help in finding centers that will perform mammograms at low cost.
A down side of mammography is a so-called false-positive result, a picture interpreted as a possible cancer when in fact there is none. Indeterminate and false-positive results may lead to further studies, such as additional mammograms or ultrasound examination. A core biopsy or surgical biopsy is obtained in 1 to 3 percent of screened women, and only 20 to 30 percent of them turn out to have breast cancer.
But the benefits of mammography still outweigh the negatives.
Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.
Pub Date: 8/20/96